September 9, 2021

Flexible microeconomic interventions can support gender affirming experiences, improve financial literacy and provide non-stigmatizing, living-wage employment for economically vulnerable transgender women. While not focused on HIV, such interventions show potential to reduce the structural drivers of HIV risk.

Dr. Tonia Poteat

Dr. Tonia Poteat

Tonia Poteat, PhD, an adjunct assistant professor of health behavior at the UNC Gillings School of Global Public health, recently co-authored a paper on the results of individual interviews with 19 adult transgender women in two United States cities (Richmond, Virginia, and St. Louis, Missouri). Interview participants all reported one or more sexual risk behaviors and recent economic hardship related to employment/income, housing or food security. The mean age of the women was 26.3 years, and 74% were racial/ethnic minorities. 89% were economically vulnerable, and 23% were employed full-time. 37% reported living with HIV.

In the U.S., transgender women experience a disproportionate burden of HIV infection along with greater challenges engaging in HIV prevention and care. HIV prevalence is 45 times higher for transgender women than for the general U.S. population, and rates are even higher for Black and Latinx transgender women. Researchers know this excess burden is driven by structural and economic inequities, but few studies have explored transgender women’s preferences for microeconomic interventions that could address the structural determinants that make this population more vulnerable to HIV infection.

After transcribing and analyzing the interviews, Poteat and her colleagues found that participants expressed strong support for unrestricted vouchers, with many expressing the need for funds to support gender-affirming interventions. They also showed strong interest in accessing budgeting assistance and career planning advice. Participants reported that visible transgender leadership, group empowerment and intentionally small group numbers would lead to more successful interventions, and they suggested conducting outreach through existing transgender networks to facilitate inclusion.

Above all, participants felt that incorporating HIV counseling and testing into a voucher intervention would be acceptable, but they preferred that HIV not be the main intervention focus.

The full BMC Public Health article is available open access.

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